Today, liver transplantation is the only simultaneous treatment of cirrhosis as well as of HCC. A crucial factor for outcome after liver transplantation is the appropriate selection of patients. Tumor diameter and node number in correlation with the histopathological grading are used as surrogate markers to predict the prognostically relevant vascular invasion. Many centers accept patients suffering from a HCC with a maximum diameter of 5 cm and up to 3 tumor nodes. Total hepatectomy and liver transplantation for patients suffering from small hepatocellular carcinoma in cirrhosis result in 5- and 10-year-survival rates of 70% and 60%, respectively. This result reflects low rates of postoperative mortality and tumor recurrence as well as a decreased mortality due to the underlying cirrhosis. In multivariate analyses, vascular invasion and histopathological grading were significant risk factors for patient survival. Histopathological grading was also identified as most important risk factor for vascular invasion.